Ventricular drainage

In a multicenter study, Jauss et al. °° evaluated the clinical features of 84 cerebellar infarction patients, and found that poor outcome was associated with a decreasing level of consciousness after clinical deterioration. Half of the patients in this study who deteriorated to coma had a meaningful recovery after undergoing ventricular drainage or suboccipital decompression, but unfortunately the trial was not randomized or controlled. 

Khanna RK, Rosenblum ML, Rock IP, Mahk GM. Prolonged external ventricular drainage with percutaneous long-tunnel ventriculostomies. J Neurosurg 1995 83(5) 791-794. 

Subarachnoid hemorrhage Surgery, BP control, nimodipine, volume expansion, sedation, seizure prophylaxis, stool softeners, ventricular drainage Neuro status, BP, hydration status, EKG, ICP... 

Insertion of a ventricular catheter can be life saving in patients with cerebellar hemorrhage and hydrocephalus. In patients with supratentorial hemorrhage and hydrocephalus, however, the benefits of cerebrospinal fluid (CSF) diversion are less certain. In patients with extensive intraventricular hemorrhage secondary to deep intraparenchymal or aneurysmal rupture, drainage of CSF is performed in some centers. Systematic reviews of observational studies suggest that this procedure may be helpful, especially when it is combined with instillation of fibrinolytic drugs. However, randomized trials are needed (Lee et al. 2003 Fountas et al. 2005). 

Remove thebesian drainage via an apical drain placed through the left ventricular apex. 

Taken together, these data indicate that left ventricular dysfunction and elevated cardiac filling pressures, hypothyroidism, and nephrotic syndrome/ hypoalbuminemia may all contribute but are not sufficient for the formation and maintenance of large persistent pleural effusion in AL amyloidosis. The incidence of exudative chemistries and the presence of amyloid deposits on pleural biopsies suggest that amyloid infiltrates and disrupts pleural mechanics, inducing fluid secretion and impairing parietal membrane drainage from the pleural space. 

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